How Rohingya Language Educational Videos Help Improve Refugee Interprofessional Health Service Delivery in Milwaukee.

Milwaukee has become home to one of the largest US populations of Rohingya refugees, who face barriers to health care, including poor service integration impeded by the absence of a formal written language. Clinicians also face barriers to delivering adequate, culturally attuned health services, so suboptimal outcomes are common. This article describes a community-based intervention using an interprofessional, multi-organizational, and ethnographically focused approach to address Rohingya refugee health needs that incorporates Rohingya participants' making educational videos in their native language. Mutually beneficial outcomes are outlined for Rohingya, students, and clinicians.

Papal Doctrines' Deep Trauma Legacies in Minoritized Communities.

Understanding papal documents from the 15th century and the nature and scope of their authority is important when working with Black, Indigenous, and people of color communities influenced by forces and structures of colonialism. Intergenerational trauma has deep roots, which require clinicians to understand historical and cultural context when working with vulnerable patients-in particular, young victims of child abuse and neglect.

Caring for Refugee Patients: An Interprofessional Course in Resettlement, Medical Intake, and Culture.

INTRODUCTION: Refugees access health care at rates similar to US citizens. Many clinicians, however, do not feel prepared to care for them. This study evaluated whether an interprofessional presentation could improve knowledge of refugee health and cross-cultural comfort. METHODS: The session consisted of a lecture and 3 small-group sessions. Students from various health care programs attended via Zoom. Participants completed pre- and postsurveys to assess cross-cultural comfort and knowledge of refugee health. RESULTS: Of 161 attendees, 63 completed the presurvey (39%) and 49 completed the postsurvey (30%). All 9 knowledge questions demonstrated statistically significant improvements, while only 1 cross-cultural question showed significant improvement. DISCUSSION: The session improved knowledge of refugee health but not cross-cultural comfort, indicating the need for further interventions.

Trauma-Informed Caring for Native American Patients and Communities Prioritizes Healing, Not Management.

Addressing intergenerational trauma remains a public health priority in Native American (NA) communities. Clinicians working with NA patients must express humility, understand local culture, collaborate, and develop an insider's perspective on NA past and present life in order to earn trust. This case considers an NA adolescent suffering from mental distress, possible substance use, and multiple traumas. The commentary argues that trauma-informed therapies are lacking in some current psychiatric and primary care practices in the Indian Health Service and that an interprofessional, trauma-informed approach that considers the interplay between relevant somatic and psychological factors can better motivate patient-centered care. Cultivating safe environments in which interventions are pursued within the patient-clinician therapeutic alliance is key to generating optimal outcomes and healing among NA patients.

Racialization as a Barrier to Achieving Health Equity for Native Americans.

Racial identity is a complex idea, particularly for American Indian and Alaska Native (AI/AN) populations. The idea of a single AI/AN race developed from a European-American view of phenotypic and cultural differences. It continues to have significant consequences for AI/AN populations within the clinical-medical context. For clinicians, using this flawed category in medical decision making poses ethical challenges and has implications for patient autonomy and justice. This article briefly traces the development of the idea of an AI/AN race, the concerns raised in using this identity marker, and the ethical implications of employing the categorization.

Little Helpers No More: A Framework for Collaborative Deprescribing of Benzodiazepines in Older Adults.

Benzodiazepines are a class of medications that tend to fly "under the radar" within the general population but nonetheless post a significant risk to older adults when not used appropriately. The current article aims to shine a spotlight on this medication class along with a framework for a team-based approach to successfully de-escalate use when clinically appropriate. [Journal of Psychosocial Nursing and Mental Health Services, 58(1), 23-28.].

The impact of a pharmacist-driven, collaborative practice on diabetes management in an Urban underserved population: a mixed method assessment.

The objective of this manuscript is to describe the results of a pharmacist-driven, Type 2 diabetes targeted, collaborative practice within an urban, underserved federally qualified health center. Pharmacists within a primary care team managed patients with chronic illnesses utilizing a collaborative practice agreement. Pharmacists, pharmacy residents, and supervised students provided care for patients with Type 2 diabetes. The first visit incorporated past medical history, medication reconciliation, determination of adherence and patient knowledge of diabetes pathophysiology, care plan, including diet and exercise, medications, and possible complications. Pharmacists had the authority to optimize medications and order laboratory tests and referrals. Diabetes, hypertension, and medication use outcomes data were collected and analyzed to assess the impact of clinical pharmacy services. Patient and provider satisfaction were assessed via surveys and focus group interviews. Ninety-nine patients were included in the evaluation. The mean A1c level was 9.8% at baseline and 8.4% at follow-up (p< .05). There were significant improvements in patient attainment of A1c <9%, ACE Inhibitor/angiotensin receptor blocker and statin use, and tobacco cessation at follow-up (p< .05). Eleven providers who responded to the satisfaction survey answered 73% of the questions with strongly agree. The seven patients who participated in the satisfaction survey, and focus group were satisfied with the care they received from the pharmacists. The focus group highlighted similar personal goals, barriers, and interests in nutrition education. Working as part of a collaborative care team, pharmacists were able to have a significant impact on improving the health outcomes of patients with Type 2 diabetes and patient and provider perceptions of the vital role of pharmacists.

Case reports of interprofessional care for clients enrolled in a mental health court.

BACKGROUND: An interprofessional mental health court (MHC) team was created in Milwaukee, Wisconsin, in 2014 to help keep low-level offenders with mental health (MH) disorders out of the correctional system. The focus of MHC is on stabilization of MH disorders and rehabilitation rather than incarceration. A clinical MH pharmacist was added to the team in 2015 to provide expertise on psychotropic medication regimens and to meet with clients for medication education. CASE REPORTS: A 58-year-old black male was admitted to the MHC after he failed to provide sex registry information. His past medical history was significant for major depressive disorder, schizophrenia, substance use disorders, and seizures. At the time of pharmacy review, medications included aspirin, levetiracetam, risperidone, ziprasidone, and paroxetine. The pharmacist identified 3 potential drug therapy problems (duplicate therapy, potential adverse drug reaction, and inadequate dosage) and sent a letter to his psychiatrist. Risperidone and ziprasidone were switched to aripiprazole, and he was referred to a neurologist. He was eventually terminated from the MHC because of multiple violations. A 34-year-old black male was admitted to the MHC for disorderly conduct and destruction of property. His past MH history was significant for schizophrenia and substance use disorders. He was not taking psychiatric medication upon admission to MHC. While the client was institutionalized for competency determination, collaboration between the MHC pharmacist and psychiatrist resulted in the prescribing of a long-acting injectable antipsychotic, which the client was stabilized on. He subsequently graduated from the MHC. DISCUSSION: Clinical MH pharmacists play a key role on MHC teams by providing medication education, identifying drug therapy problems, and communicating with the clients' medical providers. Lack of access to medical records, court schedule conflicts, and collaboration between interprofessional groups that historically have not worked together are challenges to a pharmacist working on an MHC team.

A review of cancer risk prediction models with genetic variants.

Cancer risk prediction models are important in identifying individuals at high risk of developing cancer, which could result in targeted screening and interventions to maximize the treatment benefit and minimize the burden of cancer. The cancer-associated genetic variants identified in genome-wide or candidate gene association studies have been shown to collectively enhance cancer risk prediction, improve our understanding of carcinogenesis, and possibly result in the development of targeted treatments for patients. In this article, we review the cancer risk prediction models that have been developed for popular cancers and assess their applicability, strengths, and weaknesses. We also discuss the factors to be considered for future development and improvement of models for cancer risk prediction.

Deep pharma: psychiatry, anthropology, and pharmaceutical detox.

Psychiatric medication, or psychotropics, are increasingly prescribed for people of all ages by both psychiatry and primary care doctors for a multitude of mental health and/or behavioral disorders, creating a sharp rise in polypharmacy (i.e., multiple medications). This paper explores the clinical reality of modern psychotropy at the level of the prescribing doctor and clinical exchanges with patients. Part I, Geographies of High Prescribing, documents the types of factors (pharmaceutical-promotional, historical, cultural, etc.) that can shape specific psychotropic landscapes. Ethnographic attention is focused on high prescribing in Japan in the 1990s and more recently in the Upper Peninsula of Michigan, in the US. These examples help to identify factors that have converged over time to produce specific kinds of branded psychotropic profiles in specific locales. Part II, Pharmaceutical Detox, explores a new kind of clinical work being carried out by pharmaceutically conscious doctors, which reduces the number of medications being prescribed to patients while re-diagnosing their mental illnesses. A high-prescribing psychiatrist in southeast Wisconsin is highlighted to illustrate a kind of med-checking taking place at the level of individual patients. These various examples and cases call for a renewed emphasis by anthropology to critically examine the "total efficacies" of modern pharmaceuticals and to continue to disaggregate mental illness categories in the Boasian tradition. This type of detox will require a holistic approach, incorporating emergent fields such as neuroanthropology and other kinds of creative collaborations.

Assessing the 'relative value' of diabetic patients treated through an incentivized, corporate compliance model.

Primary Care clinics in the United States continue to incentivize doctors to adhere to clinical guidelines regarding record keeping and managing specific patient disorders. This paper offers a case study of a US physician working in a system of total compliance. This narrative will illustrate how a specific system has emerged that pays doctors an end-of-year bonus for achieving compliance in four specific areas: record keeping, service hours, customer satisfaction surveys, and maintaining tight control of diabetic patients. In particular, special attention is paid to the emphasis on 'the numbers' within the corporate compliance model, and specifically, the relative value units (RVUs) used for structuring billing, labeling patients, and organizing the day-to-day activities of doctors. Although incentivized models of compliance have proved effective in managing both doctors and patients, especially in the UK, 'gaming' the system can occur. This paper identifies one example of how patients assume a hidden risk within this model by potentially being labeled noncompliant by having the wrong numbers, even when receiving good clinical care and acting medically compliant.

Uncanny scripts: understanding pharmaceutical emplotment in the aboriginal context.

This article outlines a new social reality of global psycho-pharmaceutical prescribing: the pharmaceutical family, or ;phamily.' Ethnographic case studies from Manitoba, Canada (2002 to 2004) show how pharmaceutical emplotment, involving a synergy between cultural and drug scripts, can have uncanny consequences for vulnerable groups, such as Aboriginal children. Observations and interview transcripts of high prescribing doctors are analyzed to understand the prescribing logic of using psychoactive medication, such as methylphenidate, in young Aboriginal children diagnosed with FASD and/or ADHD. Pharmaceutical narratives are presented in order to show how non-compliance to psychotropic prescribing can further marginalize Aboriginal children and is related to the history of colonial practices in Canada.

Thick prescriptions: toward an interpretation of pharmaceutical sales practices.

Anthropologists of medicine and science are increasingly studying all aspects of pharmaceutical industry practices--from research and development to the marketing of prescription drugs. This article ethnographically explores one particular stage in the life cycle of pharmaceuticals: sales and marketing. Drawing on a range of sources-investigative journalism, medical ethics, and autoethnography--the author examines the day-to-day activities of pharmaceutical salespersons, or drug reps, during the 1990s. He describes in detail the pharmaceutical gift cycle, a three-way exchange network between doctors, salespersons, and patients and how this process of exchange is currently in a state of involution. This gift economy exists to generate prescriptions (scripts) and can mask and/or perpetuate risks and side effects for patients. With implications of pharmaceutical industry practices impacting everything from the personal-psychological to the global political economy, medical anthropologists can play a lead role in the emerging scholarly discourse concerned with critical pharmaceutical studies.